Medical Director

Job Role: Utilization Management Registered Nurse REMOTE Must hold an active Massachusetts Registered Nurse (RN) license. Requires 24 years of experience in Utilization Management (UM) and 24 years of experience within a managed care environment. Hands-on experience using InterQual clinical criteria for reviewing inpatient, post-acute, and outpatient services is required. Experience working with Epic is preferred but not required. Thanks & Regards. Kirti Singh VOTO Consulting LLC Email:

Utilization Management Specialist (LCPC/LCSW-C)Introduction:The Behavioral Health Utilization Management Specialist will be responsible for performing prospective, concurrent, and retrospective reviews for authorization, appropriateness of care determination, and benefit coverage. Utilizing clinical expertise and critical thinking skills, the specialist will analyze clinical information, contracts, mandates, and medical policies to contribute to the determination of appropriateness and authoriza

Avanciers Incorporated is hiring a Clinical Coordinator for one of our clients. Role: Clinical CoordinatorLocation: Florida / Remote (as applicable)Experience: 15 years of clinical nursing experienceRequired License: Active, unrestricted Florida RN License or Compact RN LicenseJob Description:Reviews and investigates member and provider appeals involving clinical/medical necessity denials.Analyzes medical records, claims history, and clinical documentation against InterQual/MCG criteria to deter

Job Description/ Responsibilities/ Years of experience: * 4 years experience in Healthcare and PBM * Experience in clinical knowledge. * .NET C# experience as SDET * Prioritize, manage multiple assignments, and direct the work of others to meet deadlines. * Excellent communication (Verbal and Written) and collaboration skills. * Superior organization, project management, and prioritization skills. * Courteous and professional demeanor with the desire and ability to work as a team. * Ability to i